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Composition of urinary stones in children: clinical and metabolic determinants in a French tertiary care center

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Abstract

As the epidemiology of urolithiasis is constantly evolving, analyzing the composition of stones is crucial to better understand the determinants of lithogenesis. The aim of this study was to describe the composition of stones of pediatric patients in a tertiary center. Clinical and metabolic data from all pediatric patients with at least one stone that was analyzed by Fourier transformed infrared spectroscopy (FTIR) in the Hospices Civils de Lyon between 2013 and 2017 were retrospectively collected. A total of 111 patients (sex ratio 1.4:1) were included; their median ([IQR]) age was 7.5 (3.1–10.5) years. The main component of stones was calcium oxalate (weddellite for 34 (31%) stones, whewellite 23 (21%)), calcium phosphate (carbapatite 32 (29%), brushite 6 (5%), amorphous calcium phosphate 3 (3%)), struvite 5 (5%), cystine 4 (4%), uric acid 2 (2%), and ammonium acid urate 2 (2%). A total of 20 (18%) stones were pure and 24 (22%) were infectious. Carbapatite stones were the most frequent in patients < 2 years and calcium oxalate stones in patients > 2 years old. Metabolic abnormalities (most frequently hypercalciuria) were found in 50% of tested patients and in 54% of patients with infectious stones. Congenital anomalies of the kidney and/or urinary tract (CAKUT) or neurogenic bladder were present in 9/24 (38%) patients with infectious stones and 12/16 (76%) patients with bladder stones.

Conclusion: This study confirms that calcium oxalate stones are the most frequent among pediatric patients, which could reflect the nutritional habits of predisposed patients. In contrast, infectious stones are less frequent and occur mostly in association with anatomic or metabolic favoring factors.

What is Known:

• Incidence of kidney stones is increasing among children.

• Composition of kidney stones in children is constantly evolving under the influence of genetic, nutritional, environmental, and infectious factors.

What is New:

• Infectious stones are less frequent and occur mostly in case of associated anatomic or metabolic factors, particularly in older patients.

• Stone composition and accurate metabolic analysis are guiding genetic screening in suggestive situations.

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Data Availability

The datasets analyzed during the current study are available from the corresponding author.

Code availability

Not applicable

Abbreviations

1-25OH-D :

1-25 Dihydroxyvitamin D

25OH-D :

25 Hydroxyvitamin D

AAU :

Ammonium acid urate

ACP :

Amorphous calcium phosphate

CAKUT :

Congenital abnormality of kidney and/or urinary tract

CKD :

Chronic kidney disease

eGFR:

Estimate glomerular filtration rate

FTIR :

Fourier transformed infrared spectroscopy

HCL :

Hospices Civils de Lyon

IQR:

Interquartile range

PTH:

Parathyroid hormone

UTI :

Urinary tract infection

UUT :

Upper urinary tract

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Authors and Affiliations

  1. Centre de Référence des Maladies Rénales Rares, Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69500, Bron Cedex, France

    Camille Rauturier, Justine Bacchetta & Aurélia Bertholet-Thomas

  2. Laboratoire de Biochimie, Hôpital Lyon Sud, Hospices Civils de Lyon, Cedex, 69495, Pierre-Bénite, France

    Christelle Machon

  3. Urologie pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500, Bron, France

    Delphine Demède

  4. Néphrologie, Dialyse, Hypertension et Exploration Fonctionnelle Rénale, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69008, Lyon, France

    Laurence Dubourg & Justine Bacchetta

  5. Faculté de Médecine Lyon Est, Université de Lyon, 69008, Lyon, France

    Laurence Dubourg

  6. INSERM 1033, Prévention des Maladies Osseuses, 69008, Lyon, France

    Justine Bacchetta & Aurélia Bertholet-Thomas

Authors
  1. Camille Rauturier
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  2. Christelle Machon
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  4. Laurence Dubourg
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  5. Justine Bacchetta
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  6. Aurélia Bertholet-Thomas
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Contributions

CR, CM, JB and ABT contributed to the conception of the work. CM made spectrophotometry analyses. LD made biological analyses and extracted the biological data. CR collected clinical/biological data and wrote the manuscript with support of JB and ABT. JB made statisical analyses. All authors revised it critically and approved the version to be published.

Corresponding author

Correspondence to Camille Rauturier.

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Ethics approval

This retrospective and strictly observational study was approved by the local IRB (Comité d’Ethique des Hospices Civils de Lyon, session 6/7/2018).

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The authors declare no competing interests.

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Communicated by Gregorio Paolo Milani

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Rauturier, C., Machon, C., Demède, D. et al. Composition of urinary stones in children: clinical and metabolic determinants in a French tertiary care center. Eur J Pediatr 180, 3555–3563 (2021). https://doi.org/10.1007/s00431-021-04151-7

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  • DOI: https://doi.org/10.1007/s00431-021-04151-7

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